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RECEIVED <br /> LFr�La� , � � DtQ � � p <br /> <f � 2o� Environmental Health Department <br /> C CSU N I��_.__.- PUBLIC RECORDS RELEASE APPLICATION <br /> ¢ ' Greotness gravis WibDNMEWAL <br /> • --- ISR _ IT BY EMAIL <br /> V"2 AA <br /> EHD LOG NUMBER: 0-0&6 <br /> APPLICANT: Justin Bauer BUSINESSIAGENCY:Trileaf Environmental <br /> ADDRESS: 2121 West Chandler Boulevard,Suite 108 CITY/STATE/ZIP:Chandler,AZ 85224 <br /> PHONE(1): 480-850-0575 PHONE(2): FAX OR E-MAIL: j.bauer@tnleaf.corn <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT Justin Bauer - DATE <br /> 1. List up to ten addresses in the space below. Address ranges WILL NOT be accepted. Select the type(s)of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138, mail to the <br /> address indicated below, or email to info(cDslcehd.com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <br /> 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$152 deposit prior to review. t/V� <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br /> Electronic Information: [9 List[Z Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS Cc) <br /> HEALTH DEPARTMENT ( p y 9 accepted) EHD USE ONLY <br /> FILES (Specific addresses only,address ranges will not be acce ted <br /> QX Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) ) WO I CONSUMER <br /> 0 Other Cleanup Site(Non-LOP) ' 1950 West Fremont Stockton �M <br /> FXJ Hazardous Waste �m L%f K 110 0 ll 11 JI_*®/Sp DAIRY <br /> Q Tiered Permitted Facility 2 2010 West Fremont Stockton W <br /> ❑X Aboveground Tank <br /> ❑X UST (Monitoring/Removal) PWS <br /> ❑X Hazardous Materials 3 <br /> Q Spill/Release Response <br /> NI'WATER QUALITY <br /> Q Solid Waste Facility/vehicle 4 <br /> R Food Facility <br /> El Pool I Spa ITE MITIGATION <br /> D Dairy 5 <br /> Q Land Use Application Sites <br /> HOUSING <br /> F]Septic Pumper Truck/ 6 <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant NICUPA <br /> R Housing Abatement 7 AST/HM/HW <br /> F1 Motel/Hotel <br /> UPA <br /> R Chicken Ranch/Dog Kennel <br /> g UST <br /> R Medical Waste Facility <br /> Tattoo/Body Piercing SOLID WASTE <br /> Waste Tire 9 <br /> Q Complaint <br /> F]Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY <br /> • ®t ,s � � �/ ,i `1'i`ol' C.C. '� ;(1 � <br /> 3 1 t S Z 0- 0 PP,050-10 <br /> C tr C <br /> ❑ ecords provide by Staff-PPR Complete. Starr Name: — EHD 48-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />